Nam Gi-Byoung, Jin Eun-Sun, Choi HyungOh, Song Hae-Geun, Kim Sung-Hwan, Kim Ki-Hun, Hwang Eui-Seock, Park Kyoung-Min, Kim Jun, Rhee Kyoung-Suk, Choi Kee-Joon, Kim You-Ho
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Republic of Korea.
Tex Heart Inst J. 2012;39(3):372-9.
Catheter ablation of atrial fibrillation that targets complex fractionated electrogram sites has been widely applied in the management of persistent atrial fibrillation. The clinical outcomes of pulmonary vein isolation alone and pulmonary vein isolation plus the use of complex fractionated electrogram-guided ablation (CFEA) have not been fully compared in patients with paroxysmal atrial fibrillation.This prospective study included 70 patients with symptomatic paroxysmal atrial fibrillation that remained inducible after pulmonary vein isolation. For radio-frequency catheter ablation, patients were nonrandomly assigned to a control group (pulmonary vein isolation alone, Group 1, n=35) or a CFEA group (pulmonary vein isolation plus additional CFEA, Group 2, n=35). The times to first recurrence of atrial tachyarrhythmias were compared between the 2 groups.In Group 2, CFEA rendered atrial fibrillation noninducible in 16 patients (45.7%) and converted inducible atrial fibrillation into inducible atrial flutters in 12 patients (34.3%). Atrial fibrillation remained inducible in 7 patients (20%) after the combined ablation procedures. After a mean follow-up of 23 months, freedom from recurrence of atrial tachyarrhythmias was significantly higher in Group 2 than in Group 1 (P=0.037). In Group 1, all of the recurrent tachyarrhythmias were atrial fibrillation, whereas regular tachycardia was the major mechanism of recurrent arrhythmias in Group 2 (atrial tachycardia or atrial flutter in 5 of 6 patients and atrial fibrillation in 1 patient).We found that CFEA after pulmonary vein isolation significantly reduced recurrent atrial tachyarrhythmia and might modify the pattern of arrhythmia recurrence in patients with paroxysmal atrial fibrillation.
针对复杂碎裂电图部位的房颤导管消融已广泛应用于持续性房颤的治疗。对于阵发性房颤患者，单纯肺静脉隔离与肺静脉隔离加用复杂碎裂电图指导消融（CFEA）的临床疗效尚未得到充分比较。本前瞻性研究纳入了70例有症状的阵发性房颤患者，这些患者在肺静脉隔离后仍可诱发房颤。对于射频导管消融，患者被非随机分配至对照组（单纯肺静脉隔离，第1组，n = 35）或CFEA组（肺静脉隔离加额外的CFEA，第2组，n = 35）。比较两组首次房性快速心律失常复发的时间。在第2组中，CFEA使16例患者（45.7%）的房颤不能被诱发，12例患者（34.3%）的可诱发房颤转变为可诱发房扑。联合消融术后，7例患者（20%）的房颤仍可被诱发。平均随访23个月后，第2组房性快速心律失常无复发的比例显著高于第1组（P = 0.037）。在第1组中，所有复发性快速心律失常均为房颤，而在第2组中，规则性心动过速是复发性心律失常的主要机制（6例患者中有5例为房性心动过速或房扑，1例为房颤）。我们发现，肺静脉隔离后行CFEA可显著减少阵发性房颤患者房性快速心律失常的复发，并可能改变心律失常复发的模式。
